Create similar appointment form.

show in picture below , what i need

i need this button, add to cart.

thanks

Do you mean to say that you want to create similar form which you have shared in your question?

Yes it is possible to build similar form. Please take a look at the following demo form and see if it works as expected: https://form.jotform.com/92680913866974 

Feel free to clone this form for a closer look. The following guide should help you in form cloning: https://www.jotform.com/help/42-How-to-Clone-an-Existing-Form-from-a-URL

It is possible to further customize form by injecting custom css code. Do get back to us if you need any other changes.